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What are the 5 types of Urinary incontinence?
What is Urgency incontinence?
Detrusor muscle over activity
What is Stress incontinence?
Increased pressure and impaired urethral sphincter
What volume of urine loss is characteristic of stress urinary incontinence?
What volume of urine loss is characteristic of urgency urinary incontinence?
What are the main risk factors for Stress urinary incontinence?
- Women: pregnancy, childbirth, menopause, cognitive impairment, obesity and age
- Men: lower urinary tract surgery, neurologic impairment
What are the risk factors of urgency urinary incontinence?
Age, neurologic diseases, bladder outlet obstruction (like BPH)
What are the symptoms of Obstruction incontinence?
Dribbling and frequent small volume urination
What is the most common type of urinary incontinence?
What drugs classes can cause UI?
- Alpha-adrenergic agonists (Men)
- Alpha-adrenergic antagonists (Women)
- ACE inhibitors
- Anticholinergics: Antiarrhythmics, Antidiarrheals, Antihistamines, Antiparkinson agents, antispasmodics, Antiphyscholtics
- GABA agents
- Sedative hypnotics
What disease states can cause UI?
- Delirium (drugs, acute illness)
- Atrophic Vaginitis
- Endocrine (Diabetes, Calcium)
- Restricted Mobility/Retention
- Stool Impaction
- Delirium (drugs, acute illness)
- Retention (hypocontractility or outflow obstruction)
- Impacted stool/Inflammation/Infection
- Polyuria (drugs, high output states)
What drugs aggravate Stress UI?
What is the first line therapy for Stress UI?
- Kegels and Bladder training
What are the pharmacologic therapies for Stress UI?
- Alpha agonists
- Topical estrogens
What is the drug of choice of stress UI?
Duloxetine when tolerated
What is the MOA of Duloxetine?
Serotonin and norepinephrine reuptake inhibitor
What enzymes is Duloxetine metabolized by?
2D6 and 1A2
What are the negative aspects of Duloxetine (Cymbalta)?
- High rate of discontinuation due to AE
How must you discontinue Duloxetine (Cymbalta)?
Taper after long term use
What drugs are available to treat Stress UI?
- Duloxetine (Cymbalta)
- Alpha adrenergic receptor AGOnists (Phenylephrine and pseudoephrine)
Why are Phenylephrine and pseudoephrine (alpha adrenergic agonists) not first line for stress UI?
CI in HTN, Arrhythmias, CAD, MI, hyperthyroidism, renal failure, narrow-angle glaucoma
When would you use Estrogens for Stress UI?
When Urethritis or vaginitis are also present due to estrogen deficiency
What patients should not use Systemic Estrogens for Stress UI?
Hx of breast cancer
What route of administration is preferred for estrogens for stress UI?
What is the MOA of estrogens in stress UI?
Enhances sensitivity of alpha receptors
What is the first line therapy for Urge UI?
- Bladder training
What pharmacologic treatments (drug classes) are available for urge UI?
- Beta 3 agonist
- Botulinum toxin
What is the gold standard for urge UI?
What are the dosage forms for Oxybutynin (Ditropan)?
- Topical gel
- Transdermal patch
Which dosage form of Oxybutynin (Ditropan) is best tolerated, why and what is its downfall?
- XL – requires no dose adjustment
- Downfall = no effects for 4 weeks
What are the adverse effects of Oxybutynin (Ditropan)?
- Orthostatic hypotension
- Weight gain
What is the major benefit of Oxybutynin in treatment of Urge UI?
No significant DDIs
What OTC medication is available for Urge UI?